LYNX removal through endoscopy. These are our disclosures. The LYNX device consists of a series of titanium beads with a magnetic core connected with titanium wires to form a ring shape. The LYNX device is surgically implanted at the lower esophageal sphincter for management of GERD. We report a novel technique to help with endoscopic extraction of LYNX device in particular cases of erosion into the esophageal lumen. Using an emergency lithotripsy handle with a guide wire looped around the LYNX, we were able to break the LYNX titanium wire in two points and retrieve the intraesophageal portion of the LYNX. We used an ESD knife to break the visualized fibrosis on the remaining LYNX beads, followed by successful extraction. The extraction site was treated with APC followed by stent placement to mitigate against delayed perforation and prevent delayed bleeding. A 59-year-old female with a history of GERD and hiatal hernia status post multiple hiatal hernia repairs with fundiplication underwent paraesophageal hernia repair and LYNX procedure. Significant dysphagia was present after the LYNX placement and underwent multiple EGD with dilations with no improvement. On last EGD, LYNX device was found eroding into the esophageal lumen. Endoscopic extraction was elected due to her high risk for surgery. On endoscopic exam, LYNX device can be seen partially eroding into the lumen of the esophagus. Initial attempt to cut LYNX wire with loop cutter has failed. A 0.035 inch stiff guide wire was placed into the emergency lithotripsy handle and it sheathed. The handle was rotated until the stiff wire was successfully cut through the titanium wire of the links. To retrieve a large segment of the links, the process was repeated, this time while holding the cut end of the links with the snare. To maintain grasp of the links and to free the gastroscope, the snare handle was cut and the gastroscope was withdrawn. The assistant maintained hold of the snare wire. The cutting process was repeated successfully using the guide wire and the lithotripsy handle technique. The cut segment of the links was retrieved. The remaining portion of the links could not be pulled out due to visualized fibrosis. 1.5 millimeter dual knife was used to break the visible areas of fibrosis. The lynx was pushed smoothly into the stomach with clear distal attachment after dissection. The area of extraction was inspected and no obvious perforation was seen. APC was used to stimulate tissue growth and healing. Followed by placement of a through-the-scope 20mm x 150cm fully covered metal stent. The patient was admitted for observation for one day. Esophograms showed no extubation of contrast from the esophagus. The stent was removed after four weeks. Dysphasia resolved, but patient had recurrence of reflux symptoms. Discussed further treatment options on six weeks clinic follow-up, and patient decided to continue with a PPI-VID with reasonable symptom control. Patient did not want to undergo other intervention for reflux management. Eroding links are typically managed with surgical extraction. Endoscopic removal is a minimally invasive option, especially in high-risk patients. Further studies are needed to evaluate the long-term outcomes of endoscopic links extraction. Endoscopic extraction of links with lithotripsy handle and guide wire are technically feasible. The safety and efficacy of this novel technique needs to be further studied.

endoscopic extraction

LYNX device

gastroesophageal reflux disease

titanium beads

esophageal lumen erosion